-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Information about Form 990-PF and its instructions is at
www.irs.gov/form990pf
.
OMB No. 1545-0052
20
15
Open to Public Inspection
For calendar year 2015, or tax year beginning
01-01-2015
, and ending
12-31-2015
Name of foundation
DULANEY FA AND JF CHAR
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 2907 - TRUST TAX DEPT
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILSON
,
NC
278942907
A Employer identification number
54-6487683
B
Telephone number (see instructions)
(540) 665-4345
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here .............
2.
Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
4,076,881
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
Sch. B
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
87,513
87,513
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
176,950
b
Gross sales price for all assets on line 6a
1,639,931
7
Capital gain net income (from Part IV, line 2)
...
176,950
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
264,463
264,463
13
Compensation of officers, directors, trustees, etc.
48,089
48,089
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
17,251
1,270
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
45
45
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
65,385
49,404
0
0
25
Contributions, gifts, grants paid
.......
212,670
212,670
26
Total expenses and disbursements.
Add lines 24 and 25
278,055
49,404
0
212,670
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-13,592
b
Net investment income
(if negative, enter -0-)
215,059
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2015)
Form 990-PF (2015)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
45
66
66
2
Savings and temporary cash investments
.........
158,560
288,564
288,564
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
250,640
b
Investments—corporate stock (attach schedule)
.......
1,389,884
1,472,962
1,816,386
c
Investments—corporate bonds (attach schedule)
.......
1,714,009
1,844,672
1,830,502
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
297,297
190,861
141,363
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
3,810,435
3,797,125
4,076,881
17
Accounts payable and accrued expenses
..........
18
Grants payable
..................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
..................
25
Temporarily restricted
...............
26
Permanently restricted
...............
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
........
3,810,435
3,797,125
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
30
Total net assets or fund balances
(see instructions)
.....
3,810,435
3,797,125
31
Total liabilities and net assets/fund balances
(see instructions)
.
3,810,435
3,797,125
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year’s return)
...............
1
3,810,435
2
Enter amount from Part I, line 27a
.....................
2
-13,592
3
Other increases not included in line 2 (itemize)
3
352
4
Add lines 1, 2, and 3
..........................
4
3,797,195
5
Decreases not included in line 2 (itemize)
5
70
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
3,797,125
Form
990-PF
(2015)
Form 990-PF (2015)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
100. ROCKWOOD HOLDINGS INC COMMON
2013-08-07
2015-01-13
b
50000. BERKSHIRE HATHAWAY FIN DTD 01/11/05 4.85
2009-05-28
2015-01-15
c
100000. CREDIT SUISSE USA INC DTD 12/15/2004 4.8
2011-04-19
2015-01-15
d
70. COVIDIEN PLC
2014-05-08
2015-01-27
e
.03 ALBEMARLE CORP COMMON
2015-01-13
2015-02-05
.92 MEDTRONIC PLC COMMON
2015-01-27
2015-02-13
150. ABB LTD SPONSORED ADR
2008-11-19
2015-03-25
20. ACUITY BRANDS, INC. COMMON
2009-07-13
2015-03-25
60. AMETEK INC COMMON
2009-04-27
2015-03-25
60. AMPHENOL CORP CL A
2009-04-27
2015-03-25
55. ANADARKO PETE CORP.
2015-03-25
40. ANSYS INC COMMON
2009-04-27
2015-03-25
120. APPLIED MATERIALS
2008-11-19
2015-03-25
90. ASTRAZENECA PLC SPONS ADR
2009-04-27
2015-03-25
60. BERKSHIRE HATHAWAY INC CL B COMMON
2015-03-25
20. BLACKROCK INC COMMON
2012-07-26
2015-03-25
180. CABOT OIL AND GAS
2012-06-19
2015-03-25
100. CENTENE CORP
2014-02-19
2015-03-25
40. CHEVRON TEXACO CORP COMMON
2008-11-19
2015-03-25
90. COMCAST CORP NEW CL A
2011-12-15
2015-03-25
110. CONOCOPHILLIPS COM
2006-02-16
2015-03-25
120. CORNING INCORPORATED
2008-11-19
2015-03-25
70. DBS GROUP HLDGS LTD SPONSORED ADR F/K/A DEVELOPMENT BK SINGAPORE L
2009-04-27
2015-03-25
90. DELTA AIR LINES INC COMMON
2014-09-23
2015-03-25
30. DISNEY WALT COMPANY
2008-11-19
2015-03-25
70. DISCOVER FINL SVCS
2010-11-02
2015-03-25
70. DOW CHEMICAL COMPANY
2011-09-13
2015-03-25
50. EXPRESS SCRIPTS HOLDING CO COMMON
2011-12-15
2015-03-25
40. EXXON MOBIL CORPORATION
2010-01-25
2015-03-25
80. FEI COMPANY COMMON
2010-01-25
2015-03-25
70. FIDELITY NATIONAL INFORMATION SERVICES I
2011-12-15
2015-03-25
40. GENUINE PARTS COMPANY
2009-10-27
2015-03-25
12. GOOGLE INC CL A
2015-03-25
2323.557 HARDING LOEVNER INTERNATIONAL EQUITY INS
2013-01-17
2015-03-25
30. HENKEL KGAA
2011-12-15
2015-03-25
40. IHS INC COMMON
2009-04-27
2015-03-25
90. INTEL CORPORATION
2006-05-31
2015-03-25
30. LABORATORY CORP OF AMERICAN HOLDINGS
2009-04-27
2015-03-25
4. MARKEL CORP
2009-04-27
2015-03-25
70. NATIONAL-OILWELL INC
2014-12-18
2015-03-25
40. NESTLE SA ADR
2009-04-27
2015-03-25
70. NOBLE ENERGY INC
2009-07-13
2015-03-25
90. OCEANEERING INTL INC
2010-01-25
2015-03-25
70. ORACLE SYSTEM CORPORATION
2008-11-19
2015-03-25
50. PALL CORPORATION COMMON
2009-04-27
2015-03-25
90. PFIZER INCORPORATED
2012-06-19
2015-03-25
40. PHILLIPS 66 COMMON
2006-02-16
2015-03-25
50. ROBERT HALF INTL COMMON
2011-08-19
2015-03-25
20. ROPER INDS INC COMMON
2010-01-25
2015-03-25
150. SALLY BEAUTY COMPANY INC COMMON
2011-05-26
2015-03-25
40. SANDISK CORP
2014-09-23
2015-03-25
90. SCHLUMBERGER LTD
2008-11-19
2015-03-25
70. A. O. SMITH CORPORATION CLASS B
2012-07-26
2015-03-25
40. STERICYCLE INC
2009-07-13
2015-03-25
40. STRYKER CORP COMMON
2011-12-15
2015-03-25
40. TARGET CORP COM
2015-03-25
30. THE TRAVELERS COMPANIES INC.
2006-02-16
2015-03-25
50. TRIPADVISOR INC. COMMON
2014-12-18
2015-03-25
70. UNITED RENTALS INC
2012-07-26
2015-03-25
40. V F CORP COMMON
2010-01-25
2015-03-25
70. WASTE CONNECTIONS
2009-04-27
2015-03-25
100. WOLVERINE WORLD WIDE INC COMMON
2009-10-27
2015-03-25
50. ARCH CAPITAL GROUP LTD
2009-04-27
2015-03-25
330. ENSCO PLC
2014-12-18
2015-03-25
66. MEDTRONIC PLC COMMON
2015-01-27
2015-03-25
80. TE CONNECTIVITY LTD
2012-07-26
2015-03-25
150. ABB LTD SPONSORED ADR
2008-11-19
2015-03-30
20. ACUITY BRANDS, INC. COMMON
2009-07-13
2015-03-30
60. AMETEK INC COMMON
2009-04-27
2015-03-30
20. AMGEN INCORPORATED
2011-09-13
2015-03-30
60. AMPHENOL CORP CL A
2009-04-27
2015-03-30
40. ANSYS INC COMMON
2009-04-27
2015-03-30
20. ANTHEM INC COMMON
2008-11-19
2015-03-30
140. APPLIED MATERIALS
2008-11-19
2015-03-30
70. ARM HOLDINGS PLC -SPONS ADR
2012-10-18
2015-03-30
30. BERKSHIRE HATHAWAY INC CL B COMMON
2009-07-13
2015-03-30
30. BRITISH AMERICAN TOB COMMON
2009-04-27
2015-03-30
225. CORNING INCORPORATED
2008-11-19
2015-03-30
110. CROWN HOLDINGS INC COMMON
2009-10-27
2015-03-30
30. DISNEY WALT COMPANY
2008-11-19
2015-03-30
100. DOW CHEMICAL COMPANY
2011-09-13
2015-03-30
50. FIDELITY NATIONAL INFORMATION SERVICES I
2011-12-15
2015-03-30
40. FISERV
2009-04-27
2015-03-30
40. GENUINE PARTS COMPANY
2009-10-27
2015-03-30
40. JOHNSON & JOHNSON
2004-03-16
2015-03-30
30. LABORATORY CORP OF AMERICAN HOLDINGS
2009-04-27
2015-03-30
4. MARKEL CORP
2009-04-27
2015-03-30
40. NESTLE SA ADR
2009-04-27
2015-03-30
30. NOVARTIS AG
2009-04-27
2015-03-30
80. ORACLE SYSTEM CORPORATION
2008-11-19
2015-03-30
30. PALL CORPORATION COMMON
2009-04-27
2015-03-30
42. PHILLIPS 66 COMMON
2015-03-30
90. ROBERT HALF INTL COMMON
2011-08-19
2015-03-30
90. ROCHE HOLDING LTD ADR
2011-12-15
2015-03-30
20. ROPER INDS INC COMMON
2015-03-30
30. SNAP ON INC FKA SNAP ON TOOLS
2009-10-27
2015-03-30
50. TARGET CORP COM
2011-06-17
2015-03-30
30. THE TRAVELERS COMPANIES INC.
2006-02-16
2015-03-30
50. V F CORP COMMON
2010-01-25
2015-03-30
70. WASTE CONNECTIONS
2009-04-27
2015-03-30
50. ARCH CAPITAL GROUP LTD
2009-04-27
2015-03-30
100000. FED NATL MTG ASSN DTD 3/30/05 5% 04/15/2
2006-02-22
2015-04-15
130. ADT CORP COMMON
2015-03-30
2015-04-27
48. ALBEMARLE CORP COMMON
2015-01-13
2015-04-27
50. AMERICAN EXPRESS COMPANY
2014-09-23
2015-04-27
40. APPLE COMPUTER CORPORATION COMMON
2011-05-26
2015-04-27
115.428 ARTISAN INTERNATIONAL SMALL CAP FUND # 1
2013-01-22
2015-04-27
460. BANK OF AMER CORP COMMON
2014-12-18
2015-04-27
306.259 CAUSEWAY INTERNATL VALUE-INS
2014-05-14
2015-04-27
1277.626 CAUSEWAY INTERNATL VALUE-INS
2014-02-24
2015-04-27
50. CITRIX SYSTEMS
2015-03-30
2015-04-27
30. EOG RESOURCES INC
2014-09-11
2015-04-27
70. FACEBOOK INC-A COMMON
2015-03-30
2015-04-27
70. FLOWSERVE CORP COM
2015-03-30
2015-04-27
40. GILEAD SCIENCES INC
2014-09-23
2015-04-27
221.822 HARBOR INTERNATIONAL FUND
2014-09-11
2015-04-27
348.382 HARDING LOEVNER INTERNATIONAL EQUITY INS
2013-01-17
2015-04-27
100. HILTON WORLDWIDE HOLDINGS INC COMMON
2015-03-30
2015-04-27
70. MEADWESTVACO CORP.
2015-03-30
2015-04-27
130. METLIFE COMMON
2015-03-30
2015-04-27
470.092 OPPENHEIMER DEVELOPING MARKETS FUND CL Y
2014-02-24
2015-04-27
776.759 PIMCO COMMODITY REAL RETURN STRATEGY INS
2014-09-11
2015-04-27
20. PRECISION CASTPARTS CORP
2014-09-23
2015-04-27
70. RAYONIER ADVANCED MATERIALS COMMON
2009-07-13
2015-04-27
110. ROYAL DUTCH SHELL PLC ADR CL B
2014-12-18
2015-04-27
210. THE TIMKEN COMPANY COMMON
2015-04-27
170. VODAFONE GROUP PLC -SP ADR
2014-12-18
2015-04-27
60. PENTAIR PLC
2015-04-27
.033 GOOGLE INC CLASS C COMMON
2013-08-07
2015-05-12
70. ABBOTT LABORATORIES
2015-04-27
2015-06-24
120. CBRE GROUP INC COMMON
2015-03-30
2015-06-24
53.999 CAUSEWAY INTERNATL VALUE-INS
2015-03-25
2015-06-24
7321.883 CAUSEWAY INTERNATL VALUE-INS
2014-02-24
2015-06-24
677.156 COHEN & STEERS REALTY SHARES INSTITUTION
2014-02-19
2015-06-24
40. DIRECTV COMMON
2015-04-27
2015-06-24
190. FORD MOTOR COMPANY
2015-03-25
2015-06-24
60. GENERAL MILLS, INCORPORATED
2015-04-27
2015-06-24
80. HCP INC COMMON
2015-03-25
2015-06-24
160. HOST MARRIOTT CORP NEW COM
2015-03-30
2015-06-24
50000. JPMORGAN CHASE & CO DTD 06/24/2010 3.4%
2011-03-25
2015-06-24
50. MEDNAX INC COMMON
2015-03-25
2015-06-24
130. MICRON TECHNOLOGY INCORPORATED COMMON
2014-09-23
2015-06-24
90. MYRIAD GENETICS INC COMMON
2015-04-27
2015-06-24
60. PHILIP MORRIS INTERNATIONAL
2014-05-08
2015-06-24
3. PRICELINE GROUP INC/THE COMMON
2015-03-25
2015-06-24
50. SCOTTS CO CL A
2014-12-18
2015-06-24
170. SPECTRA ENERGY CORPORATION
2015-06-24
30. UNITED PARCEL SERVICES B
2014-12-18
2015-06-24
50. VENTAS INC COMMON
2015-03-25
2015-06-24
.242 TALEN COMMON ENERGY CORP
2014-12-18
2015-06-30
50000. US TREASURY BOND DTD 8/15/05 4.25% 08/15
2005-09-23
2015-08-15
70. PALL CORPORATION COMMON
2009-04-27
2015-08-31
100000. BANK OF AMERICA CORP DTD 08/20/10 3.7% 0
2011-04-27
2015-09-01
19. CHEMOURS CO/THE COMMON
2008-11-19
2015-09-11
210. RAYONIER INC COMMON
2009-07-13
2015-09-11
11. TALEN COMMON ENERGY CORP
2014-12-18
2015-09-11
50000. HEWLETT-PACKARD CO DTD 09/13/2010 2.125%
2011-03-31
2015-09-13
5869.55 PIMCO COMMODITY REAL RETURN STRATEGY INS
2015-11-19
1192.236 PIMCO COMMODITY REAL RETURN STRATEGY INS
2015-06-24
2015-11-19
50. SPDR GOLD TRUST
2008-11-19
2015-11-19
14. BIOGEN INC COMMON
2015-03-25
2015-11-25
6130.483 CAUSEWAY INTERNATL VALUE-INS
2015-03-25
2015-11-25
300. CLEAN HARBORS INC COMMON
2015-11-25
60. CLEAN HARBORS INC COMMON
2014-05-08
2015-11-25
1180. DARLING INTERNATIONAL INC COMMON
2015-11-25
570. DARLING INTERNATIONAL INC COMMON
2015-11-25
90. DEVON ENERGY CORPORATION NEW
2014-12-18
2015-11-25
200. HALLIBURTON COMPANY
2014-12-18
2015-11-25
100. HILTON WORLDWIDE HOLDINGS INC COMMON
2015-03-30
2015-11-25
100. NCR CORPORATION - W/I
2015-03-30
2015-11-25
50. RYMAN HOSPITALITY PROPERTIES INC COMMON
2015-04-27
2015-11-25
40. TRIPADVISOR INC. COMMON
2015-06-24
2015-11-25
80. WILLIAMS COS INC
2015-03-30
2015-11-25
100000. THERMO FISHER SCIENTIFIC DTD 02/22/2011
2015-12-15
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
7,922
6,508
1,414
b
50,000
51,120
-1,120
c
100,000
105,916
-5,916
d
7,546
5,028
2,518
e
1
2
-1
69
70
-1
3,224
1,512
1,712
3,257
516
2,741
3,155
864
2,291
3,488
984
2,504
4,514
2,564
1,950
3,476
1,094
2,382
2,777
1,064
1,713
6,383
3,274
3,109
8,627
3,476
5,151
7,314
3,302
4,012
5,251
3,287
1,964
6,988
3,041
3,947
4,207
2,914
1,293
5,134
2,101
3,033
6,930
5,070
1,860
2,762
1,037
1,725
4,119
1,682
2,437
4,050
3,402
648
3,154
615
2,539
4,010
1,259
2,751
3,286
1,834
1,452
4,181
2,172
2,009
3,394
2,644
750
6,251
1,735
4,516
4,750
1,772
2,978
3,740
1,459
2,281
6,844
4,640
2,204
43,265
37,665
5,600
3,569
1,689
1,880
4,426
1,643
2,783
2,703
1,626
1,077
3,861
1,851
2,010
3,088
1,141
1,947
3,427
4,535
-1,108
3,080
1,282
1,798
3,237
1,909
1,328
4,792
2,550
2,242
3,016
1,166
1,850
5,028
1,277
3,751
3,108
2,044
1,064
3,182
1,096
2,086
3,031
1,069
1,962
3,419
1,027
2,392
5,201
2,490
2,711
3,304
3,994
-690
7,508
4,466
3,042
4,454
1,724
2,730
5,569
1,972
3,597
3,719
1,865
1,854
3,257
1,900
1,357
3,245
1,305
1,940
4,219
3,737
482
6,284
1,906
4,378
2,985
727
2,258
3,357
1,197
2,160
3,210
1,323
1,887
3,108
929
2,179
7,159
9,740
-2,581
5,191
5,013
178
5,703
2,577
3,126
3,211
1,512
1,699
3,404
516
2,888
3,150
864
2,286
3,272
1,090
2,182
3,505
984
2,521
3,516
1,094
2,422
3,139
666
2,473
3,199
1,242
1,957
3,452
2,009
1,443
4,356
1,693
2,663
3,192
1,397
1,795
5,182
1,944
3,238
5,839
2,913
2,926
3,195
615
2,580
4,865
2,620
2,245
3,417
1,266
2,151
3,173
733
2,440
3,756
1,459
2,297
4,066
1,704
2,362
3,815
1,851
1,964
3,056
1,141
1,915
3,072
1,282
1,790
3,034
1,106
1,928
3,470
1,333
2,137
3,049
766
2,283
3,338
785
2,553
5,467
1,924
3,543
3,080
1,914
1,166
3,467
975
2,492
4,366
1,097
3,269
4,118
2,333
1,785
3,279
1,305
1,974
3,759
908
2,851
3,360
1,197
2,163
3,122
929
2,193
100,000
100,692
-692
5,293
5,435
-142
2,840
2,855
-15
3,869
4,458
-589
5,313
1,920
3,393
3,027
2,655
372
7,220
8,022
-802
5,044
5,035
9
21,043
20,800
243
3,360
3,211
149
2,923
3,076
-153
5,795
5,777
18
4,043
4,003
40
4,173
4,241
-68
16,140
15,847
293
6,811
5,647
1,164
3,038
2,969
69
3,318
3,524
-206
6,615
6,627
-12
17,299
16,881
418
3,449
4,210
-761
4,057
4,797
-740
1,087
1,281
-194
7,040
7,525
-485
8,535
9,307
-772
5,995
5,984
11
3,749
4,315
-566
18
15
3
3,481
3,370
111
4,486
4,354
132
870
843
27
118,029
119,200
-1,171
32,605
29,788
2,817
3,730
3,610
120
2,961
3,096
-135
3,398
3,371
27
2,980
3,369
-389
3,324
3,234
90
50,000
50,355
-355
3,706
3,633
73
3,152
4,057
-905
3,108
3,051
57
4,885
5,163
-278
3,458
3,460
-2
2,974
3,106
-132
5,676
6,534
-858
2,997
3,310
-313
3,168
3,630
-462
5
5
50,000
50,014
-14
8,904
1,787
7,117
100,000
100,987
-987
174
123
51
4,746
3,543
1,203
142
215
-73
50,000
50,000
39,385
63,253
-23,868
8,000
10,253
-2,253
5,174
3,633
1,541
4,084
6,043
-1,959
89,444
95,697
-6,253
12,899
16,603
-3,704
2,580
3,613
-1,033
12,543
17,779
-5,236
6,059
10,695
-4,636
4,137
5,320
-1,183
7,891
7,821
70
2,335
2,969
-634
2,723
3,016
-293
2,708
3,011
-303
3,314
3,580
-266
2,905
4,032
-1,127
100,580
100,745
-165
15,478
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
1,414
b
-1,120
c
-5,916
d
2,518
e
-1
-1
1,712
2,741
2,291
2,504
1,950
2,382
1,713
3,109
5,151
4,012
1,964
3,947
1,293
3,033
1,860
1,725
2,437
648
2,539
2,751
1,452
2,009
750
4,516
2,978
2,281
2,204
5,600
1,880
2,783
1,077
2,010
1,947
-1,108
1,798
1,328
2,242
1,850
3,751
1,064
2,086
1,962
2,392
2,711
-690
3,042
2,730
3,597
1,854
1,357
1,940
482
4,378
2,258
2,160
1,887
2,179
-2,581
178
3,126
1,699
2,888
2,286
2,182
2,521
2,422
2,473
1,957
1,443
2,663
1,795
3,238
2,926
2,580
2,245
2,151
2,440
2,297
2,362
1,964
1,915
1,790
1,928
2,137
2,283
2,553
3,543
1,166
2,492
3,269
1,785
1,974
2,851
2,163
2,193
-692
-142
-15
-589
3,393
372
-802
9
243
149
-153
18
40
-68
293
1,164
69
-206
-12
418
-761
-740
-194
-485
-772
11
-566
3
111
132
27
-1,171
2,817
120
-135
27
-389
90
-355
73
-905
57
-278
-2
-132
-858
-313
-462
-14
7,117
-987
51
1,203
-73
-23,868
-2,253
1,541
-1,959
-6,253
-3,704
-1,033
-5,236
-4,636
-1,183
70
-634
-293
-303
-266
-1,127
-165
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
176,950
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2014
212,000
4,448,540
0.047656
2013
215,000
4,388,192
0.048995
2012
209,895
4,266,757
0.049193
2011
207,800
4,342,111
0.047857
2010
200,225
4,205,849
0.047606
2
Total
of line 1, column (d)
.....................
2
0.241307
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years
.
.
.
3
0.048261
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5
.....
4
4,221,471
5
Multiply line 4 by line 3
......................
5
203,732
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,151
7
Add lines 5 and 6
........................
7
205,883
8
Enter qualifying distributions from Part XII, line 4
.............
8
212,670
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form
990-PF
(2015)
Form 990-PF (2015)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
2,151
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
...........................
3
2,151
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
2,151
6
Credits/Payments:
a
2015 estimated tax payments and 2014 overpayment credited to 2015
6a
9,472
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
9,472
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
7,321
11
Enter the amount of line 10 to be:
Credited to 2015 estimated tax
1,076
Refunded
11
6,245
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
VA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2015)
Form 990-PF (2015)
Page
5
Part VII-A
Statements Regarding Activities (continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions)
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement (see instructions)
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
BRANCH BANKING AND TRUST
Telephone no.
(540) 665-4345
Located at
148 S QUEEN STREET
MARTINSBURG
WV
ZIP+4
25401
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—Check here
.......
and enter the amount of tax-exempt interest received or accrued during the year
......
15
16
At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
16
No
See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)?
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2015?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2015?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
No
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2015 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2015.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?
4b
No
Form
990-PF
(2015)
Form 990-PF (2015)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(Continued)
5a
During the year did the foundation pay or incur any amount to:
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? (see instructions)
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)?
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If yes, did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
Form
990-PF
(2015)
Form 990-PF (2015)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
BRANCH BANKING AND TRUST COMPANY
TRUSTEE
10
48,089
148 S QUEEN STREET
MARTINSBURG
,
WV
25401
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2015)
Form 990-PF (2015)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations,see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
4,110,890
b
Average of monthly cash balances
.......................
1b
174,867
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
4,285,757
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
4,285,757
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
64,286
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
4,221,471
6
Minimum investment return.
Enter 5% of line 5
..................
6
211,074
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
211,074
2a
Tax on investment income for 2015 from Part VI, line 5
......
2a
2,151
b
Income tax for 2015. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,151
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
208,923
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
208,923
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
208,923
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
212,670
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
212,670
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b (see instructions)
.................
5
2,151
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
210,519
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2015)
Form 990-PF (2015)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2014
(c)
2014
(d)
2015
1
Distributable amount for 2015 from Part XI, line 7
208,923
2
Undistributed income, if any, as of the end of 2015:
a
Enter amount for 2014 only
.......
212,670
b
Total for prior years:
2013
,
20
,
20
0
3
Excess distributions carryover, if any, to 2015:
a
From 2010
......
0
b
From 2011
......
0
c
From 2012
......
0
d
From 2013
......
0
e
From 2014
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2015 from Part
XII, line 4:
$
212,670
a
Applied to 2014, but not more than line 2a
212,670
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2015 distributable amount
.....
0
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2015.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2014. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2016. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2015
..........
208,923
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2010 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2016.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2011
....
0
b
Excess from 2012
....
0
c
Excess from 2013
....
0
d
Excess from 2014
....
0
e
Excess from 2015
....
0
Form
990-PF
(2015)
Form 990-PF (2015)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2015, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2015
(b)
2014
(c)
2013
(d)
2012
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the organization had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2015)
Form 990-PF (2015)
Page
11
Part XV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
CONGREGATIONAL COMMUNITY ACTION
PROGRAM OF WINCHESTER
PO BOX 2112
WINCHESTER
,
VA
22604
NONE
EXEMPT
CHARITABLE
42,534
BLUE RIDGE AREA FOOD BANK
ATTN MICHAEL MCKEE CEO
VERONA
,
VA
24482
NONE
EXEMPT
CHARITABLE
42,534
1ST BAPTIST CHURCH OF WINCHESTER
ATTN JOHN D BEAVERS TREASURER
205 WEST PICCADILLY ST
WINCHESTER
,
VA
22601
NONE
EXEMPT
CHARITABLE
42,534
FREE MEDICAL CLINIC OF WINC
ATTN VICKI MCCLELLAND EXEC DIR
WINCHESTER
,
VA
22601
NONE
EXEMPT
CHARITABLE
42,534
ADULT CARE CENTER OF THE
NORTHERN SHENANDOAH VALLEY
115 WOLFE STREET
WINCHESTER
,
VA
22601
NONE
EXEMPT
CHARITABLE
42,534
Total
.................................
3a
212,670
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2015)
Form 990-PF (2015)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash investments
...........
4
Dividends and interest from securities
....
14
87,513
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than inventory
............
18
176,950
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
..
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
264,463
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
264,463
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2015)
Form 990-PF (2015)
Page
13
Part XVII
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
...................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
...........................
1b(4)
No
(5)
Loans or loan guarantees
.............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column
(b)
should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column
(d)
the value of the goods, other assets, or services received.
(a)
Line No.
(b)
Amount involved
(c)
Name of noncharitable exempt organization
(d)
Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2015)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
TY 2015 OtherDecreasesSchedule
Name:
DULANEY FA AND JF CHAR
EIN:
54-6487683
Description
Amount
DIFFERENCE IN MUTUAL FUNDS RECEIVED/REPORTED
70
-
TIN:
TY 2015 OtherIncreasesSchedule
Name:
DULANEY FA AND JF CHAR
EIN:
54-6487683
Description
Amount
COST BASIS ADJUSTMENT
349
ROUNDING
3